Are Hospitals More Deadly Than Ebola?

We’ve all been horrified by the medical blunders made in dealing with Ebola in the United States—from sending home a patient who was showing symptoms and had recently travelled to West Africa to relying on inadequate protocols or protection that led to the infection of two of his nurses.

It’s awful, but we shouldn’t be surprised. These types of hospital mistakes—caused by knowledge gaps, carelessness, unpreparedness or a combination of all—by my estimate kill between 210,000 and 440,000 people in the United States every year. The numbers indicate that preventable medical errors—from infections to botched surgeries to administration of the wrong medicine—are the third leading cause of death in the country, behind only heart disease and cancer. It is gratifying and heartbreaking at the same time to know that my research has been endorsed by leading experts in this field.

Story Continued Below

I’m not a physician, but I am a medical scientist by training, having worked at NASA for 25 years as the agency’s chief toxicologist. My involuntary journey to medical investigator and critic of the U.S. health-care system began in 2002 when my son, John Alexander (“Alex”), collapsed while running on the Baylor University campus in Waco, Texas. His doctors were accustomed to seeing older patients with clogged cardiac arteries or folks with progressive heart failure. But when an athletic, 19-year-old man showed up in their emergency room one evening, they were unprepared to make the correct diagnosis. He was subjected to numerous non-invasive tests and two expensive, invasive and inconclusive tests.

After five days of evaluation they were unable to determine what had caused his collapse. He was discharged and instructed to show up five days later for a follow-up visit with a physician-in-training. She gave him a clean bill of health, not knowing that his cardiologists wanted his running restricted. A few days later he was running alone on his college campus. He collapsed again, but this time he did not recover. Lack of oxygen to his brain sent him into a deep coma from which he died three days later in the hospital—the same one where he had originally been seen.

As I inspected Alex’s medical records, I noted three catastrophic mistakes that contributed to his death: failure to follow a guideline from the National Council on Potassium in Clinical Practice for replacement of potassium, an electrolyte essential for normal heart function that gets severely depleted with the type of running my son was doing in hot and humid Texas; failure to diagnose a cardiac abnormality that is typically easy to identify through an electrocardiogram and patient history; and failure to tell him not to resume running even though they wrote this in his medical record. His written discharge only instructed him to avoid driving for 24 hours.

It’s harder than you might think to figure out how many American families suffer similar tragedies. A few years after my son died I came across several studies that tried to calculate “harmful adverse events”—many of which are due to medical errors. To detect these errors, the studies primarily used the Global Trigger Tool from the Institute for Healthcare Improvement, a Cambridge, Mass.-based nonprofit dedicated to improving health and healthcare worldwide. The tool is used by a trained nurse or physician to scan medical records for evidence of an adverse event that harmed the patient. Among the clues, or trigger, that medical personnel are trained to look for to identify a possible adverse event are a patient’s transfer to a higher level of care or the abrupt stoppage of a particular medication.

By 2012 four studies had been published that attempted to identify preventable adverse events in hospitals, but no one was using the findings to improve on the estimate from the Institute of Medicine that up to 98,000 lethal medical errors were occurring each year in the United States. That estimate, published in 1999 and titled “To Err is Human,” was based on data from 1984. It was extremely old. The modern studies were based on medical records from 2002 to 2008.

I also noted that each study was small and would never stand alone. But combining the results of the four studies would lead to a scientifically defensible estimate of lethal, preventable adverse events. By combining the studies and using rough estimates of the preventability of the adverse events and the total number of hospitalizations (roughly 35 million) in the year 2007, I estimated that every year 210,000 people have their lives ended prematurely by mistakes in their care while hospitalized in the United States.

The most common lethal adverse events involved infection (26 percent), medication (18 percent), aspiration or pulmonary system (11 percent), procedure (11 percent), and kidney or endocrine system (8 percent). The remainder (26 percent) involved other systems or was unspecified in the original studies.

To be counted, the premature death need not occur in the hospital where the error was committed. For example, the nicking of the bowel of the late Rep. John Murtha during routine surgery in 2010 caused an infection that manifested days after his discharge. Sadly, by the time he was returned to another hospital for care, it was too late to save his life.

Discovering that 210,000 people die each year due to medical errors identifiable using the Global Trigger Tool was almost incomprehensible, but it was not the end of my work. And the conclusions would be even more startling. Knowing the limitations of the Global Trigger Tool to identify errors of omission, communication, and diagnoses, and the fact that medical records often make evidence of medical errors difficult to find, I raised the estimate to 440,000 deaths per year, the details of which are contained in my journal paper, “A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care.” The Global Trigger Tool, for example, would not have detected any of the three catastrophic errors evident in my son’s medical records.

How can medical errors be reduced? The fundamental problem with our health-care industry is that it functions on a free-enterprise model. Marketing of drugs, devices, hospital care and outpatient care is at the core of the industry. This model could work for patients if they had full transparency into the costs and quality of care rendered by providers. But patients do not have that insight. They attempt to protect themselves from inordinate costs with health insurance, but that often fails and bankruptcy follows.

Furthermore, as a people we are not in this together. Those with money can presumably buy quality health care, but those without are typically marginalized to public care that is less accessible and of reduced quality.

There are strategies that could be implemented now to improve hospital care. I just finished co-editing a book with Dr. Cheryl Brown that surveys the problems with quality in our medical industry and how to correct many of these.

Among the strategies we propose:

• Make the National Practitioner Data Bank—a national database of physician sanctions—open to the public;

• Give the public access to facility-specific, validated enumerations of health-care-acquired infections and adverse events in hospitals and ambulatory surgical centers.

• Require that results of hospital accreditation status be made a matter of public record.

• Conduct anonymous, 360-degree performance reviews of professionals with hospital privileges that include feedback from patients, subordinates, colleagues and administrators.

• Perform job-satisfaction surveys of representative members of the hospital staff. All results must be made public.

We all must face the loss of loved ones and friends. But it should never be because of preventable mistakes made by those who are supposed to make them better. America’s current health-care system fails patients in far too many ways and far too often. It failed my son and it fails hundreds of thousands of others every year. This is inexcusable, especially in the richest nation on Earth. It is time for legislatures and federal agencies to put patients first and address this problem.

John T. James, Ph.D., is former chief toxicologist for NASA and founder of Patient Safety America, a Houston-based organization that advocates for better quality healthcare and patients’ rights. He is the author of the book, “A Sea of Broken Hearts—Patient Rights in a Dangerous, Profit-Driven Health Care System,” and co-editor of the soon-to-be-released book, “The Truth about Big Medicine: Righting the Wrongs for Better Health Care.”